In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to EACVI Silver Members, Fellows of the ESC and Young combined Members

Multimodality imaging and long-term outcome after pericardiectomy for constrictive pericarditis: a single center case series

Session Poster session 2

Speaker Bernard P Paelinck

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Pericardium
  • Session type : Poster Session

Authors : B P Paelinck (Edegem,BE), S Laga (Edegem,BE), D De Bock (Edegem,BE), JM Bosmans (Edegem,BE), MJ Claeys (Edegem,BE), S Haine (Edegem,BE), T Vermeulen (Edegem,BE), PM Parizel (Edegem,BE), IE Rodrigus (Edegem,BE)

Authors:
B P Paelinck1 , S Laga1 , D De Bock1 , JM Bosmans1 , MJ Claeys1 , S Haine1 , T Vermeulen1 , PM Parizel1 , IE Rodrigus1 , 1Antwerp University Hospital - Edegem - Belgium ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii371

Background/introduction:
Although constrictive pericarditis (CP) is associated with high morbidity and mortality, the diagnosis of CP often remains challenging. Pericardiectomy is considered the standard therapy for CP. Data on long-term outcome of pericardiectomy are limited.
Purpose:
To analyze multimodality diagnostic performance, clinical outcome and risk factors for perioperative and long-term complications and survival in patients treated with pericardiectomy for CP.
Methods:
Single center, retrospective study of patients who underwent pericardiectomy. Data on multimodality imaging (echocardiography, CMR and/or CT) and clinical status at baseline, postoperative and at follow-up were analyzed.
Results:
Sixteen patients (age 74 years (53-81)) underwent partial (n: 9) or complete (n: 7) pericardiectomy between 2012 and 2018. CMR was performed in 9 patients, CT in 7 patients (pacemaker: 1, alfapump: 1, CT and CMR: 2, no availability of CMR: 3). In 2 patients CP was diagnosed incidentally peroperatively (aortic valve replacement: 1, coronary bypass: 1, both had dyspnea NYHA III). In 14 patients CP was diagnosed preoperatively combining clinical picture (dyspnea NYHA IV (n:4), III (n:8), II (n:2), edema (n: 14), ascites (n:7), pleural effusion (n:10)), preserved left ventricular ejection fraction 60% (45 ā€“ 77) (except one patient (LVEF:18%)), high filling pressures but preserved Eā€™, presence of septal bounce (CMR n:9), thickened pericardium =0,4 cm (n:9) and pericardial calcifications (n:5). Late gadolinium enhancement was present in 5 patients. The time duration between onset symptoms and diagnosis was 1 year (3 months ā€“ 4 years). CP was confirmed histologically in all patients. CP ethiology was post-radiation (n:1), post-cardiac surgery (n:4), post-pericarditis (n:3), reumatoid arthritis (n:2), renal insufficiency (n:3) and idiopathic in 3 patients. One patient died due to irreversible cardiogenic shock 11 days postop. Postop course was complicated with prolonged hospitalization (15 days (7-107)), prolonged congestion (n:6), pulmonary embolism (n:1) and renal insufficiency (n:7). Follow-up period was 35 months (1-66). Dyspnea dropped to NYHA I (n:9) and NYHA II (n:3) but remained NYHA III in 3 patients despite maintenance of high dosages of diuretics (n:4).
Conclusions:
CP remains a difficult and even incidental diagnosis, requiring a long diagnostic time period often. A high grade of suspicion for CP in heart failure symptoms (often including ascites and pleural effusion) with normal left ventricular ejection fraction is crucial, complemented by integrative echoDoppler and multimodality imaging (CMR/CT). The choice of one or multiple imaging modalities is driven by the clinical context and availability of each technique. Pericardiectomy is followed by prolonged and complicated postop course often. Identification of risk factors for postoperative complications needs further study.

Members get more

Join now
  • 1ESC Professional Members – access all resources from general ESC events 
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s resources
  • 3Under 40 or in training - with a Combined Membership, access all resources
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are